An estimated 886 bleeding control courses were offered in the days leading up to March 31, the official day of observance, and on the day of the event itself. These courses were led by approximately 3,460 instructors who are now filing reports with the American College of Surgeons (ACS) Stop the Bleed^® office on the number of attendees who completed the training.

Media coverage of the event was significant, with hundreds of local media reports released about the Stop the Bleed Day in their hometown newspapers, television stations, online blogs, and other media outlets across the nation. To date, Stop the Bleed Day has captured 798 media mentions and more than 736 million media impressions.

The ACS Bleedingcontrol.org website was a major source of information about the day. In fact, during the month of March the website experienced a high volume of traffic (174,253 page views). The ACS National Stop the Bleed Day web page (www.bleedingcontrol.org/march31) captured 5,487 page views, and an informational video (goo.gl/QLRnwC) explaining what the event was about captured more than 1,200 views on YouTube. Stop the Bleed training can now be found in all 50 states and in 65 countries.
 

An estimated 886 bleeding control courses were offered in the days leading up to March 31, the official day of observance, and on the day of the event itself. These courses were led by approximately 3,460 instructors who are now filing reports with the American College of Surgeons (ACS) Stop the Bleed^® office on the number of attendees who completed the training.

Media coverage of the event was significant, with hundreds of local media reports released about the Stop the Bleed Day in their hometown newspapers, television stations, online blogs, and other media outlets across the nation. To date, Stop the Bleed Day has captured 798 media mentions and more than 736 million media impressions.

The ACS Bleedingcontrol.org website was a major source of information about the day. In fact, during the month of March the website experienced a high volume of traffic (174,253 page views). The ACS National Stop the Bleed Day web page (www.bleedingcontrol.org/march31) captured 5,487 page views, and an informational video (goo.gl/QLRnwC) explaining what the event was about captured more than 1,200 views on YouTube. Stop the Bleed training can now be found in all 50 states and in 65 countries.
 

An estimated 886 bleeding control courses were offered in the days leading up to March 31, the official day of observance, and on the day of the event itself. These courses were led by approximately 3,460 instructors who are now filing reports with the American College of Surgeons (ACS) Stop the Bleed^® office on the number of attendees who completed the training.

Media coverage of the event was significant, with hundreds of local media reports released about the Stop the Bleed Day in their hometown newspapers, television stations, online blogs, and other media outlets across the nation. To date, Stop the Bleed Day has captured 798 media mentions and more than 736 million media impressions.

The ACS Bleedingcontrol.org website was a major source of information about the day. In fact, during the month of March the website experienced a high volume of traffic (174,253 page views). The ACS National Stop the Bleed Day web page (www.bleedingcontrol.org/march31) captured 5,487 page views, and an informational video (goo.gl/QLRnwC) explaining what the event was about captured more than 1,200 views on YouTube. Stop the Bleed training can now be found in all 50 states and in 65 countries.
 

The American College of Surgeons (ACS) has posted the results of the 2017 Member Survey conducted last summer, to which more than 4,400 ACS Fellows and Associate Fellows responded. An infographic (available at www.facs.org/member-services/2017-survey provides an overview of member response rates, along with information on member work settings, overall satisfaction, the value of membership, the likelihood of recommending membership to others, top member benefits by importance and satisfaction, and member experiences with ACS Chapters. The ACS also has posted more detailed survey findings, available at www.facs.org/member-services/2017-survey/findings along with descriptions of the actions being taken in response to the results.

The survey results were presented to the Board of Regents at its October 2017 meeting. In addition, the results were discussed with the ACS Executive Leadership Team and have been used to develop the 2018 ACS strategic plan.

We value your membership and appreciate you providing this useful feedback. Questions or comments should be directed to the Division of Member Services at [email protected].

The American College of Surgeons (ACS) has posted the results of the 2017 Member Survey conducted last summer, to which more than 4,400 ACS Fellows and Associate Fellows responded. An infographic (available at www.facs.org/member-services/2017-survey provides an overview of member response rates, along with information on member work settings, overall satisfaction, the value of membership, the likelihood of recommending membership to others, top member benefits by importance and satisfaction, and member experiences with ACS Chapters. The ACS also has posted more detailed survey findings, available at www.facs.org/member-services/2017-survey/findings along with descriptions of the actions being taken in response to the results.

The survey results were presented to the Board of Regents at its October 2017 meeting. In addition, the results were discussed with the ACS Executive Leadership Team and have been used to develop the 2018 ACS strategic plan.

We value your membership and appreciate you providing this useful feedback. Questions or comments should be directed to the Division of Member Services at [email protected].

The American College of Surgeons (ACS) has posted the results of the 2017 Member Survey conducted last summer, to which more than 4,400 ACS Fellows and Associate Fellows responded. An infographic (available at www.facs.org/member-services/2017-survey provides an overview of member response rates, along with information on member work settings, overall satisfaction, the value of membership, the likelihood of recommending membership to others, top member benefits by importance and satisfaction, and member experiences with ACS Chapters. The ACS also has posted more detailed survey findings, available at www.facs.org/member-services/2017-survey/findings along with descriptions of the actions being taken in response to the results.

The survey results were presented to the Board of Regents at its October 2017 meeting. In addition, the results were discussed with the ACS Executive Leadership Team and have been used to develop the 2018 ACS strategic plan.

We value your membership and appreciate you providing this useful feedback. Questions or comments should be directed to the Division of Member Services at [email protected].

The American College of Surgeons (ACS) Women in Surgery Committee (WiSC) is accepting nominations for the annual Dr. Mary Edwards Walker Inspiring Women in Surgery Award through May 31. The award will be presented at Clinical Congress 2018 in Boston, MA, in recognition of an individual’s significant contributions to the advancement of women in the field of surgery.

The award is named in honor of Mary Edwards Walker, MD, for her role as the first woman surgeon employed by the U.S. Army and the only woman to receive the Congressional Medal of Honor, the highest U.S. Armed Forces decoration for bravery. Dr. Walker’s example paved the way for women surgeons of today.

Nominees must have demonstrated a commitment to the advancement and inspiration of women in surgery and be members of the ACS, either in active practice or retired. WiSC members are ineligible for this award. The awardee is expected to attend Clinical Congress 2018 to accept the honor in person.

All nominations must be accompanied by the following documents:

• A letter of nomination outlining how the nominee has contributed to the advancement of women in the field of surgery

• An up-to-date curriculum vitae (CV) of the nominee

• Self-nominations are acceptable and should include a letter of reference

The letter of nomination and CV should be sent to Connie Bura at [email protected].

Read more about Dr. Walker, complete award eligibility requirements, and the selection process on the ACS website at www.facs.org/about-acs/governance/acs-committees/women-in-surgery-committee/edwards-walker. Questions can be submitted to [email protected].

The American College of Surgeons (ACS) Women in Surgery Committee (WiSC) is accepting nominations for the annual Dr. Mary Edwards Walker Inspiring Women in Surgery Award through May 31. The award will be presented at Clinical Congress 2018 in Boston, MA, in recognition of an individual’s significant contributions to the advancement of women in the field of surgery.

The award is named in honor of Mary Edwards Walker, MD, for her role as the first woman surgeon employed by the U.S. Army and the only woman to receive the Congressional Medal of Honor, the highest U.S. Armed Forces decoration for bravery. Dr. Walker’s example paved the way for women surgeons of today.

Nominees must have demonstrated a commitment to the advancement and inspiration of women in surgery and be members of the ACS, either in active practice or retired. WiSC members are ineligible for this award. The awardee is expected to attend Clinical Congress 2018 to accept the honor in person.

All nominations must be accompanied by the following documents:

• A letter of nomination outlining how the nominee has contributed to the advancement of women in the field of surgery

• An up-to-date curriculum vitae (CV) of the nominee

• Self-nominations are acceptable and should include a letter of reference

The letter of nomination and CV should be sent to Connie Bura at [email protected].

Read more about Dr. Walker, complete award eligibility requirements, and the selection process on the ACS website at www.facs.org/about-acs/governance/acs-committees/women-in-surgery-committee/edwards-walker. Questions can be submitted to [email protected].

The American College of Surgeons (ACS) Women in Surgery Committee (WiSC) is accepting nominations for the annual Dr. Mary Edwards Walker Inspiring Women in Surgery Award through May 31. The award will be presented at Clinical Congress 2018 in Boston, MA, in recognition of an individual’s significant contributions to the advancement of women in the field of surgery.

The award is named in honor of Mary Edwards Walker, MD, for her role as the first woman surgeon employed by the U.S. Army and the only woman to receive the Congressional Medal of Honor, the highest U.S. Armed Forces decoration for bravery. Dr. Walker’s example paved the way for women surgeons of today.

Nominees must have demonstrated a commitment to the advancement and inspiration of women in surgery and be members of the ACS, either in active practice or retired. WiSC members are ineligible for this award. The awardee is expected to attend Clinical Congress 2018 to accept the honor in person.

All nominations must be accompanied by the following documents:

• A letter of nomination outlining how the nominee has contributed to the advancement of women in the field of surgery

• An up-to-date curriculum vitae (CV) of the nominee

• Self-nominations are acceptable and should include a letter of reference

The letter of nomination and CV should be sent to Connie Bura at [email protected].

Read more about Dr. Walker, complete award eligibility requirements, and the selection process on the ACS website at www.facs.org/about-acs/governance/acs-committees/women-in-surgery-committee/edwards-walker. Questions can be submitted to [email protected].

The family and friends of the late Claude H. Organ, Jr., MD, FACS, Past-President of the American College of Surgeons (ACS), have established an endowment through the ACS Foundation to provide funding for an annual fellowship to be awarded to an outstanding young surgeon from the Society of Black Academic Surgeons, the Association of Women Surgeons, or the Surgical Section of the National Medical Association. The ACS is accepting applications for the Claude H. Organ, Jr., MD, FACS, Traveling Fellowship through June 1.

The fellowship, in the amount of $5,000, enables a U.S. or Canadian Fellow or Associate Fellow younger than 45 years old who is a member of one of the previously mentioned societies to attend an educational meeting or make an extended visit to an institution of his or her choice, tailored to his or her research interests.

Past awardees have used their fellowships to develop their careers in creative ways. The 2017 fellow, Kakra Hughes, MD, FACS, visited locations in Ethiopia and Ghana to begin to develop partnerships and a program for resident training in vascular surgery.

The full requirements for the Claude H. Organ, Jr., MD, FACS, Traveling Fellowship are posted on the ACS website at www.facs.org/member-services/scholarships/special/organ. A decision regarding this year’s awardee is scheduled to be announced in August 2018. Questions and application materials should be submitted to the attention of the ACS Scholarships Administrator at [email protected].

The family and friends of the late Claude H. Organ, Jr., MD, FACS, Past-President of the American College of Surgeons (ACS), have established an endowment through the ACS Foundation to provide funding for an annual fellowship to be awarded to an outstanding young surgeon from the Society of Black Academic Surgeons, the Association of Women Surgeons, or the Surgical Section of the National Medical Association. The ACS is accepting applications for the Claude H. Organ, Jr., MD, FACS, Traveling Fellowship through June 1.

The fellowship, in the amount of $5,000, enables a U.S. or Canadian Fellow or Associate Fellow younger than 45 years old who is a member of one of the previously mentioned societies to attend an educational meeting or make an extended visit to an institution of his or her choice, tailored to his or her research interests.

Past awardees have used their fellowships to develop their careers in creative ways. The 2017 fellow, Kakra Hughes, MD, FACS, visited locations in Ethiopia and Ghana to begin to develop partnerships and a program for resident training in vascular surgery.

The full requirements for the Claude H. Organ, Jr., MD, FACS, Traveling Fellowship are posted on the ACS website at www.facs.org/member-services/scholarships/special/organ. A decision regarding this year’s awardee is scheduled to be announced in August 2018. Questions and application materials should be submitted to the attention of the ACS Scholarships Administrator at [email protected].

The family and friends of the late Claude H. Organ, Jr., MD, FACS, Past-President of the American College of Surgeons (ACS), have established an endowment through the ACS Foundation to provide funding for an annual fellowship to be awarded to an outstanding young surgeon from the Society of Black Academic Surgeons, the Association of Women Surgeons, or the Surgical Section of the National Medical Association. The ACS is accepting applications for the Claude H. Organ, Jr., MD, FACS, Traveling Fellowship through June 1.

The fellowship, in the amount of $5,000, enables a U.S. or Canadian Fellow or Associate Fellow younger than 45 years old who is a member of one of the previously mentioned societies to attend an educational meeting or make an extended visit to an institution of his or her choice, tailored to his or her research interests.

Past awardees have used their fellowships to develop their careers in creative ways. The 2017 fellow, Kakra Hughes, MD, FACS, visited locations in Ethiopia and Ghana to begin to develop partnerships and a program for resident training in vascular surgery.

The full requirements for the Claude H. Organ, Jr., MD, FACS, Traveling Fellowship are posted on the ACS website at www.facs.org/member-services/scholarships/special/organ. A decision regarding this year’s awardee is scheduled to be announced in August 2018. Questions and application materials should be submitted to the attention of the ACS Scholarships Administrator at [email protected].

AUSTIN, TEX. – Canagliflozin can improve renal outcomes in patients with type 2 diabetes, even when they have mild or moderate kidney disease, new data from the CANVAS program suggested.

“The effect of canagliflozin on composite renal outcomes was large, particularly in people with preserved kidney function,” Brendon L. Neuen, MBBS, of University of New South Wales, Sydney, and his associates wrote in a poster. Baseline renal function also did not appear to affect the safety of canagliflozin, the investigators reported at a meeting sponsored by the National Kidney Foundation.

In patients with diabetes mellitus, increased proximal reabsorption of glucose and sodium decreases the amount of sodium reaching the macula densa in the distal convoluted tubule. This results in reduced use of adenosine triphosphate for sodium reabsorption, which thereby decreases adenosine release and vasoconstriction of afferent arterioles. Left unchecked, this dampening of the tubuloglomerular feedback mechanism increases glomerular filtration and leads to diabetic nephropathy.

Sodium glucose cotransporter 2 (SGLT2) inhibitors such as canagliflozin (Invokana) and empagliflozin (Jardiance) help mitigate this pathology by vasoconstricting afferent arterioles. Previously, in an exploratory analysis of the multicenter, placebo-controlled EMPA-REG OUTCOME (Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes) trial, empagliflozin led to modest but statistically significant long-term reductions in urinary albumin secretion for diabetic patients, regardless of their baseline urinary albumin to creatinine ratio (Lancet Diabetes Endocrinol. 2017 Aug;5[8]:610-21). Treatment with empagliflozin also significantly reduced the risk of developing microalbuminuria or macroalbuminuria (P less than .0001).

The multicenter, double-blind, placebo-controlled CANVAS (Canagliflozin Cardiovascular Assessment Study) and CANVAS-R (A Study of the Effects of Canagliflozin on Renal Endpoints in Adult Participants with Type 2 Diabetes Mellitus) trials included more than 10,000 adults with type 2 diabetes and high cardiovascular risk. In the primary analysis, canagliflozin significantly reduced the risk of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke compared with placebo (N Engl J Med. 2017 Aug 17;377[7]:644-57).

Dr. Neuen and his associates compared the effects of canagliflozin on renal outcomes and safety among CANVAS patients whose estimated glomerular filtration rate (eGFR) was preserved (greater than 60 mL/min per 1.73 m²) or reduced (less than 60 ml/min per 1.73 m²). Actual mean eGFRs in each of these groups were 83 mL/min per 1.73 m² and 49 mL/min per 1.73 m², respectively. Compared with placebo, canagliflozin acutely reduced eGFR in patients with either preserved (average, –2.2 mL/min per 1.73 m²) or reduced (–2.83 mL/min/1.73 m² ) baseline kidney function (P = 0.21).

SOURCE: Neuen BL et al. SCM 2018.
 

AUSTIN, TEX. – Canagliflozin can improve renal outcomes in patients with type 2 diabetes, even when they have mild or moderate kidney disease, new data from the CANVAS program suggested.

“The effect of canagliflozin on composite renal outcomes was large, particularly in people with preserved kidney function,” Brendon L. Neuen, MBBS, of University of New South Wales, Sydney, and his associates wrote in a poster. Baseline renal function also did not appear to affect the safety of canagliflozin, the investigators reported at a meeting sponsored by the National Kidney Foundation.

In patients with diabetes mellitus, increased proximal reabsorption of glucose and sodium decreases the amount of sodium reaching the macula densa in the distal convoluted tubule. This results in reduced use of adenosine triphosphate for sodium reabsorption, which thereby decreases adenosine release and vasoconstriction of afferent arterioles. Left unchecked, this dampening of the tubuloglomerular feedback mechanism increases glomerular filtration and leads to diabetic nephropathy.

Sodium glucose cotransporter 2 (SGLT2) inhibitors such as canagliflozin (Invokana) and empagliflozin (Jardiance) help mitigate this pathology by vasoconstricting afferent arterioles. Previously, in an exploratory analysis of the multicenter, placebo-controlled EMPA-REG OUTCOME (Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes) trial, empagliflozin led to modest but statistically significant long-term reductions in urinary albumin secretion for diabetic patients, regardless of their baseline urinary albumin to creatinine ratio (Lancet Diabetes Endocrinol. 2017 Aug;5[8]:610-21). Treatment with empagliflozin also significantly reduced the risk of developing microalbuminuria or macroalbuminuria (P less than .0001).

The multicenter, double-blind, placebo-controlled CANVAS (Canagliflozin Cardiovascular Assessment Study) and CANVAS-R (A Study of the Effects of Canagliflozin on Renal Endpoints in Adult Participants with Type 2 Diabetes Mellitus) trials included more than 10,000 adults with type 2 diabetes and high cardiovascular risk. In the primary analysis, canagliflozin significantly reduced the risk of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke compared with placebo (N Engl J Med. 2017 Aug 17;377[7]:644-57).

Dr. Neuen and his associates compared the effects of canagliflozin on renal outcomes and safety among CANVAS patients whose estimated glomerular filtration rate (eGFR) was preserved (greater than 60 mL/min per 1.73 m²) or reduced (less than 60 ml/min per 1.73 m²). Actual mean eGFRs in each of these groups were 83 mL/min per 1.73 m² and 49 mL/min per 1.73 m², respectively. Compared with placebo, canagliflozin acutely reduced eGFR in patients with either preserved (average, –2.2 mL/min per 1.73 m²) or reduced (–2.83 mL/min/1.73 m² ) baseline kidney function (P = 0.21).

SOURCE: Neuen BL et al. SCM 2018.
 

AUSTIN, TEX. – Canagliflozin can improve renal outcomes in patients with type 2 diabetes, even when they have mild or moderate kidney disease, new data from the CANVAS program suggested.

“The effect of canagliflozin on composite renal outcomes was large, particularly in people with preserved kidney function,” Brendon L. Neuen, MBBS, of University of New South Wales, Sydney, and his associates wrote in a poster. Baseline renal function also did not appear to affect the safety of canagliflozin, the investigators reported at a meeting sponsored by the National Kidney Foundation.

In patients with diabetes mellitus, increased proximal reabsorption of glucose and sodium decreases the amount of sodium reaching the macula densa in the distal convoluted tubule. This results in reduced use of adenosine triphosphate for sodium reabsorption, which thereby decreases adenosine release and vasoconstriction of afferent arterioles. Left unchecked, this dampening of the tubuloglomerular feedback mechanism increases glomerular filtration and leads to diabetic nephropathy.

Sodium glucose cotransporter 2 (SGLT2) inhibitors such as canagliflozin (Invokana) and empagliflozin (Jardiance) help mitigate this pathology by vasoconstricting afferent arterioles. Previously, in an exploratory analysis of the multicenter, placebo-controlled EMPA-REG OUTCOME (Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes) trial, empagliflozin led to modest but statistically significant long-term reductions in urinary albumin secretion for diabetic patients, regardless of their baseline urinary albumin to creatinine ratio (Lancet Diabetes Endocrinol. 2017 Aug;5[8]:610-21). Treatment with empagliflozin also significantly reduced the risk of developing microalbuminuria or macroalbuminuria (P less than .0001).

The multicenter, double-blind, placebo-controlled CANVAS (Canagliflozin Cardiovascular Assessment Study) and CANVAS-R (A Study of the Effects of Canagliflozin on Renal Endpoints in Adult Participants with Type 2 Diabetes Mellitus) trials included more than 10,000 adults with type 2 diabetes and high cardiovascular risk. In the primary analysis, canagliflozin significantly reduced the risk of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke compared with placebo (N Engl J Med. 2017 Aug 17;377[7]:644-57).

Dr. Neuen and his associates compared the effects of canagliflozin on renal outcomes and safety among CANVAS patients whose estimated glomerular filtration rate (eGFR) was preserved (greater than 60 mL/min per 1.73 m²) or reduced (less than 60 ml/min per 1.73 m²). Actual mean eGFRs in each of these groups were 83 mL/min per 1.73 m² and 49 mL/min per 1.73 m², respectively. Compared with placebo, canagliflozin acutely reduced eGFR in patients with either preserved (average, –2.2 mL/min per 1.73 m²) or reduced (–2.83 mL/min/1.73 m² ) baseline kidney function (P = 0.21).

SOURCE: Neuen BL et al. SCM 2018.
 

BOSTON – A company that partners patients and health advisers claims to help patients with type 2 diabetes to manage their symptoms and lower their HbA_1c levels.

The Pack Health program connects each patient with a health adviser, who contacts them five times a week using a mix of phone calls, text messages, and emails. The goals include helping patients to find clinicians in their area, make appointments, and adhere to treatment, Dhiren Patel, PharmD, medical director at Pack Health, said at the annual meeting of the American Association of Clinical Endocrinologists.

In a prospective study of 756 type 2 diabetes patients, traditional modes of communication with a health coach were associated with a 1% decrease in HbA_1c within 3 months and the reduction was maintained at 1 year. Patients lost an average of 5 pounds, and annual eye and foot exams increased by 17% and 19%, respectively.

Similar remote health coach initiatives are being used to help other patients with chronic health conditions as part of the Pack Health services, which Dr. Patel discussed in a video interview.

[email protected]

SOURCE: Patel D et al. AACE 2018. Abstract 1209.

BOSTON – A company that partners patients and health advisers claims to help patients with type 2 diabetes to manage their symptoms and lower their HbA_1c levels.

The Pack Health program connects each patient with a health adviser, who contacts them five times a week using a mix of phone calls, text messages, and emails. The goals include helping patients to find clinicians in their area, make appointments, and adhere to treatment, Dhiren Patel, PharmD, medical director at Pack Health, said at the annual meeting of the American Association of Clinical Endocrinologists.

In a prospective study of 756 type 2 diabetes patients, traditional modes of communication with a health coach were associated with a 1% decrease in HbA_1c within 3 months and the reduction was maintained at 1 year. Patients lost an average of 5 pounds, and annual eye and foot exams increased by 17% and 19%, respectively.

Similar remote health coach initiatives are being used to help other patients with chronic health conditions as part of the Pack Health services, which Dr. Patel discussed in a video interview.

[email protected]

SOURCE: Patel D et al. AACE 2018. Abstract 1209.

BOSTON – A company that partners patients and health advisers claims to help patients with type 2 diabetes to manage their symptoms and lower their HbA_1c levels.

The Pack Health program connects each patient with a health adviser, who contacts them five times a week using a mix of phone calls, text messages, and emails. The goals include helping patients to find clinicians in their area, make appointments, and adhere to treatment, Dhiren Patel, PharmD, medical director at Pack Health, said at the annual meeting of the American Association of Clinical Endocrinologists.

In a prospective study of 756 type 2 diabetes patients, traditional modes of communication with a health coach were associated with a 1% decrease in HbA_1c within 3 months and the reduction was maintained at 1 year. Patients lost an average of 5 pounds, and annual eye and foot exams increased by 17% and 19%, respectively.

Similar remote health coach initiatives are being used to help other patients with chronic health conditions as part of the Pack Health services, which Dr. Patel discussed in a video interview.

[email protected]

SOURCE: Patel D et al. AACE 2018. Abstract 1209.

MADRID – Seven days of antibiotic therapy was just as effective as 14 days for patients with Gram-negative bacteremias.

The shorter course was associated with similar cure rates and a faster return to normal activities, Dafna Yahav, MD, said at the European Society of Clinical Microbiology and Infectious Diseases annual congress.

Michele G. Sullivan/MDedge News

“In patients hospitalized with Gram-negative bacteremia and sepsis, a course of 7 antibiotic days was not inferior to 14 days, and resulted in a more rapid return to baseline activity, “ said Dr. Yahav of the Rabin Medical Center, Petah Tikva, Israel. “This could lead to a change in accepted management algorithms and shortened antibiotic therapy. Potentially, though we did not show this in our trial, it may lead to reduced cost, reduced development of resistance, and fewer adverse events.”

During the past few years, a new dogma has emerged in antibiotic treatment paradigms, she said: Shorter is better. Brad Spellberg, MD, described this concept in his 2016 editorial in JAMA Internal Medicine, “The new antibiotic mantra” (Sep 1;176[9]:1254-5).

In it, Dr. Spellberg, of the University of Southern California, Los Angeles, addressed the long-held view that a full 10- or 14-day course of antibiotics was necessary to decrease the risk of creating a resistant strain, even if clinical symptoms were long resolved.

However, he noted, there is little evidence supporting the idea that longer courses suppress the rise of resistance – and, in fact, some data support the opposite.

“To the contrary, specifically for pneumonia, studies have shown that longer courses of therapy result in more emergence of antibiotic resistance, which is consistent with everything we know about natural selection, the driver of antibiotic resistance,” he noted. “In only a few types of infections does resistance emerge at the site of infection; rather, resistance typically emerges off target, among colonizing flora away from the site of infection. Thus, all that is achieved by treating an infection with antibiotics for longer than the patient has symptoms is increased selective pressure driving antibiotic resistance among our colonizing microbial flora.”

The primary outcome was a composite 90-day endpoint of all-cause mortality, clinical failure (relapse, new local complications, or distant complications), and readmission or hospital stay longer than 14 days. There were a number of secondary outcomes, including new infection, emergence of antibiotic resistance, total hospital and total antibiotic days, time to return to baseline activity, and adverse events.

The cohort was a mean of 71 years old. About 60% were functionally independent, and the mean Charlson comorbidity score was 2. Most of the infections (90%) were nosocomial. The urinary tract was the largest source of infection (69%). Other sources were abdominal, respiratory, central venous catheter, and skin or soft tissue.

Escherichia coli was the most common infective organism (62%), followed by Klebsiella species and Enterobacteriaceae. A small number of patients had Acinetobacter and Pseudomonas infections.

In the intent-to-treat analysis, the primary composite outcome of all-cause mortality or extended hospital stay occurred in 46% of the 7-day group and 50% of the 14-day group – not significantly different. The results were nearly identical in the per-protocol analysis (46% vs. 49.6%).

[email protected]

SOURCE: Yahav D et al. ECCMID 2018. Oral abstract O1120.

MADRID – Seven days of antibiotic therapy was just as effective as 14 days for patients with Gram-negative bacteremias.

The shorter course was associated with similar cure rates and a faster return to normal activities, Dafna Yahav, MD, said at the European Society of Clinical Microbiology and Infectious Diseases annual congress.

Michele G. Sullivan/MDedge News

“In patients hospitalized with Gram-negative bacteremia and sepsis, a course of 7 antibiotic days was not inferior to 14 days, and resulted in a more rapid return to baseline activity, “ said Dr. Yahav of the Rabin Medical Center, Petah Tikva, Israel. “This could lead to a change in accepted management algorithms and shortened antibiotic therapy. Potentially, though we did not show this in our trial, it may lead to reduced cost, reduced development of resistance, and fewer adverse events.”

During the past few years, a new dogma has emerged in antibiotic treatment paradigms, she said: Shorter is better. Brad Spellberg, MD, described this concept in his 2016 editorial in JAMA Internal Medicine, “The new antibiotic mantra” (Sep 1;176[9]:1254-5).

In it, Dr. Spellberg, of the University of Southern California, Los Angeles, addressed the long-held view that a full 10- or 14-day course of antibiotics was necessary to decrease the risk of creating a resistant strain, even if clinical symptoms were long resolved.

However, he noted, there is little evidence supporting the idea that longer courses suppress the rise of resistance – and, in fact, some data support the opposite.

“To the contrary, specifically for pneumonia, studies have shown that longer courses of therapy result in more emergence of antibiotic resistance, which is consistent with everything we know about natural selection, the driver of antibiotic resistance,” he noted. “In only a few types of infections does resistance emerge at the site of infection; rather, resistance typically emerges off target, among colonizing flora away from the site of infection. Thus, all that is achieved by treating an infection with antibiotics for longer than the patient has symptoms is increased selective pressure driving antibiotic resistance among our colonizing microbial flora.”

The primary outcome was a composite 90-day endpoint of all-cause mortality, clinical failure (relapse, new local complications, or distant complications), and readmission or hospital stay longer than 14 days. There were a number of secondary outcomes, including new infection, emergence of antibiotic resistance, total hospital and total antibiotic days, time to return to baseline activity, and adverse events.

The cohort was a mean of 71 years old. About 60% were functionally independent, and the mean Charlson comorbidity score was 2. Most of the infections (90%) were nosocomial. The urinary tract was the largest source of infection (69%). Other sources were abdominal, respiratory, central venous catheter, and skin or soft tissue.

Escherichia coli was the most common infective organism (62%), followed by Klebsiella species and Enterobacteriaceae. A small number of patients had Acinetobacter and Pseudomonas infections.

In the intent-to-treat analysis, the primary composite outcome of all-cause mortality or extended hospital stay occurred in 46% of the 7-day group and 50% of the 14-day group – not significantly different. The results were nearly identical in the per-protocol analysis (46% vs. 49.6%).

[email protected]

SOURCE: Yahav D et al. ECCMID 2018. Oral abstract O1120.

MADRID – Seven days of antibiotic therapy was just as effective as 14 days for patients with Gram-negative bacteremias.

The shorter course was associated with similar cure rates and a faster return to normal activities, Dafna Yahav, MD, said at the European Society of Clinical Microbiology and Infectious Diseases annual congress.

Michele G. Sullivan/MDedge News

“In patients hospitalized with Gram-negative bacteremia and sepsis, a course of 7 antibiotic days was not inferior to 14 days, and resulted in a more rapid return to baseline activity, “ said Dr. Yahav of the Rabin Medical Center, Petah Tikva, Israel. “This could lead to a change in accepted management algorithms and shortened antibiotic therapy. Potentially, though we did not show this in our trial, it may lead to reduced cost, reduced development of resistance, and fewer adverse events.”

During the past few years, a new dogma has emerged in antibiotic treatment paradigms, she said: Shorter is better. Brad Spellberg, MD, described this concept in his 2016 editorial in JAMA Internal Medicine, “The new antibiotic mantra” (Sep 1;176[9]:1254-5).

In it, Dr. Spellberg, of the University of Southern California, Los Angeles, addressed the long-held view that a full 10- or 14-day course of antibiotics was necessary to decrease the risk of creating a resistant strain, even if clinical symptoms were long resolved.

However, he noted, there is little evidence supporting the idea that longer courses suppress the rise of resistance – and, in fact, some data support the opposite.

“To the contrary, specifically for pneumonia, studies have shown that longer courses of therapy result in more emergence of antibiotic resistance, which is consistent with everything we know about natural selection, the driver of antibiotic resistance,” he noted. “In only a few types of infections does resistance emerge at the site of infection; rather, resistance typically emerges off target, among colonizing flora away from the site of infection. Thus, all that is achieved by treating an infection with antibiotics for longer than the patient has symptoms is increased selective pressure driving antibiotic resistance among our colonizing microbial flora.”

The primary outcome was a composite 90-day endpoint of all-cause mortality, clinical failure (relapse, new local complications, or distant complications), and readmission or hospital stay longer than 14 days. There were a number of secondary outcomes, including new infection, emergence of antibiotic resistance, total hospital and total antibiotic days, time to return to baseline activity, and adverse events.

The cohort was a mean of 71 years old. About 60% were functionally independent, and the mean Charlson comorbidity score was 2. Most of the infections (90%) were nosocomial. The urinary tract was the largest source of infection (69%). Other sources were abdominal, respiratory, central venous catheter, and skin or soft tissue.

Escherichia coli was the most common infective organism (62%), followed by Klebsiella species and Enterobacteriaceae. A small number of patients had Acinetobacter and Pseudomonas infections.

In the intent-to-treat analysis, the primary composite outcome of all-cause mortality or extended hospital stay occurred in 46% of the 7-day group and 50% of the 14-day group – not significantly different. The results were nearly identical in the per-protocol analysis (46% vs. 49.6%).

[email protected]

SOURCE: Yahav D et al. ECCMID 2018. Oral abstract O1120.

Diarrhea associated with enterotoxigenic Escherichia coli (ETEC) infection is more severe among individuals with blood type A, based on data from 106 adults exposed to the agent.

The reseachers speculate that the increased severity is related, in part, to the presence of an adhesin molecule known as EtpA, which binds to the surface of the cells and combines with blood group A glycans to promote a more severe infection.

“Our studies suggest that the many ETEC strains that produce the EtpA adhesin may be particularly well equipped to preferentially infect hosts who express A blood group antigen on mucosal surfaces,” wrote Pardeep Kumar, MD, of Washington University, Saint Louis, and his colleagues.

ETEC, associated with choleralike illness, remains a major cause of infectious diarrhea in developing countries. No current vaccine offers significant protection against it, but EtpA may be useful in vaccine development. “More recently discovered virulence factors and an improved understanding of ETEC microbial pathogenesis could offer additional avenues to protect those at highest risk for severe disease and uncover novel molecular targets for future vaccine development,” the researchers said.

In a study published in the Journal of Clinical Investigation, the researchers examined blood samples from 106 adults who had participated in previous human infection model studies. The volunteers were challenged with an ETEC strain known as H10407 that was originally isolated from a case of choleralike illness.

Diarrhea was more frequent among A blood type individuals, compared with other types. Individuals with B or O blood types were significantly more likely to have no diarrhea or mild diarrhea after the E. coli challenge, compared with type A individuals (44% vs. 19%).

Overall, significantly more individuals with A or AB blood types developed moderate to severe diarrhea, compared with those with B or O blood types (81% vs. 56%). In addition, significantly more individuals with blood type A needed early initiation of antibiotic therapy, compared with those with B or O blood types (72% vs. 43%).

SOURCE: Kumar P et al. J Clin Invest. 2018 May 17. doi: 10.1172/JCI97659.

Diarrhea associated with enterotoxigenic Escherichia coli (ETEC) infection is more severe among individuals with blood type A, based on data from 106 adults exposed to the agent.

The reseachers speculate that the increased severity is related, in part, to the presence of an adhesin molecule known as EtpA, which binds to the surface of the cells and combines with blood group A glycans to promote a more severe infection.

“Our studies suggest that the many ETEC strains that produce the EtpA adhesin may be particularly well equipped to preferentially infect hosts who express A blood group antigen on mucosal surfaces,” wrote Pardeep Kumar, MD, of Washington University, Saint Louis, and his colleagues.

ETEC, associated with choleralike illness, remains a major cause of infectious diarrhea in developing countries. No current vaccine offers significant protection against it, but EtpA may be useful in vaccine development. “More recently discovered virulence factors and an improved understanding of ETEC microbial pathogenesis could offer additional avenues to protect those at highest risk for severe disease and uncover novel molecular targets for future vaccine development,” the researchers said.

In a study published in the Journal of Clinical Investigation, the researchers examined blood samples from 106 adults who had participated in previous human infection model studies. The volunteers were challenged with an ETEC strain known as H10407 that was originally isolated from a case of choleralike illness.

Diarrhea was more frequent among A blood type individuals, compared with other types. Individuals with B or O blood types were significantly more likely to have no diarrhea or mild diarrhea after the E. coli challenge, compared with type A individuals (44% vs. 19%).

Overall, significantly more individuals with A or AB blood types developed moderate to severe diarrhea, compared with those with B or O blood types (81% vs. 56%). In addition, significantly more individuals with blood type A needed early initiation of antibiotic therapy, compared with those with B or O blood types (72% vs. 43%).

SOURCE: Kumar P et al. J Clin Invest. 2018 May 17. doi: 10.1172/JCI97659.

Diarrhea associated with enterotoxigenic Escherichia coli (ETEC) infection is more severe among individuals with blood type A, based on data from 106 adults exposed to the agent.

The reseachers speculate that the increased severity is related, in part, to the presence of an adhesin molecule known as EtpA, which binds to the surface of the cells and combines with blood group A glycans to promote a more severe infection.

“Our studies suggest that the many ETEC strains that produce the EtpA adhesin may be particularly well equipped to preferentially infect hosts who express A blood group antigen on mucosal surfaces,” wrote Pardeep Kumar, MD, of Washington University, Saint Louis, and his colleagues.

ETEC, associated with choleralike illness, remains a major cause of infectious diarrhea in developing countries. No current vaccine offers significant protection against it, but EtpA may be useful in vaccine development. “More recently discovered virulence factors and an improved understanding of ETEC microbial pathogenesis could offer additional avenues to protect those at highest risk for severe disease and uncover novel molecular targets for future vaccine development,” the researchers said.

In a study published in the Journal of Clinical Investigation, the researchers examined blood samples from 106 adults who had participated in previous human infection model studies. The volunteers were challenged with an ETEC strain known as H10407 that was originally isolated from a case of choleralike illness.

Diarrhea was more frequent among A blood type individuals, compared with other types. Individuals with B or O blood types were significantly more likely to have no diarrhea or mild diarrhea after the E. coli challenge, compared with type A individuals (44% vs. 19%).

Overall, significantly more individuals with A or AB blood types developed moderate to severe diarrhea, compared with those with B or O blood types (81% vs. 56%). In addition, significantly more individuals with blood type A needed early initiation of antibiotic therapy, compared with those with B or O blood types (72% vs. 43%).

SOURCE: Kumar P et al. J Clin Invest. 2018 May 17. doi: 10.1172/JCI97659.

BOSTON – The effects of canagliflozin on hemoglobin A_1c levels were greater in participants under age 65 years in randomized clinical trials of the SGLT2 inhibitor, according to results of a prespecified subgroup analysis.

Some cardiovascular, renal, and mortality outcomes also varied by age group, according to the analysis of participants in the CANVAS (Canagliflozin Cardiovascular Assessment Study) program. Despite those differences, the effect of canagliflozin was generally consistent on other outcomes, such as body weight and blood pressure, in patient grouped into those aged less than 65 years and those aged 65 years and older, investigators reported at the annual meeting of the American Association of Clinical Endocrinologists.

Nonfatal MI, nonfatal stroke, and the composite of doubling of serum creatine, end-stage renal disease, or renal death were lower in study participants aged 65 and older on canagliflozin. Lower risks of cardiovascular death and all-cause mortality were seen in participants under age 65 years who were taking canagliflozin. However, “these results should be interpreted with caution given the large number of subgroup analyses performed,” wrote Fernando Ovalle, MD, director of the multidisciplinary comprehensive diabetes clinic at the University of Alabama at Birmingham, and his colleagues.

Canagliflozin was found to reduce risk of the composite endpoint of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke versus placebo in previously published results of the CANVAS study, which included individuals with type 2 diabetes mellitus who either had or were at high risk for having cardiovascular disease.

The two multicenter, randomized, controlled trials, CANVAS and CANVAS-R, included more than 10,000 patients. The subgroup analysis presented here at the AACE meeting included 5,578 patients aged less than 65 years (55%) and 4,564 patients aged 65 years or older (45%).

The subgroup analysis found that placebo-subtracted differences in HbA1c were greater in patients under 65 years than those in patients 65 or older (–0.7% and –0.5%, respectively; P less than .0001). However, there were no significant differences by age group in body weight changes, systolic blood pressure, or diastolic blood pressure.

SOURCE: Ovalle F et al. AACE 2018, Abstract 233.

BOSTON – The effects of canagliflozin on hemoglobin A_1c levels were greater in participants under age 65 years in randomized clinical trials of the SGLT2 inhibitor, according to results of a prespecified subgroup analysis.

Some cardiovascular, renal, and mortality outcomes also varied by age group, according to the analysis of participants in the CANVAS (Canagliflozin Cardiovascular Assessment Study) program. Despite those differences, the effect of canagliflozin was generally consistent on other outcomes, such as body weight and blood pressure, in patient grouped into those aged less than 65 years and those aged 65 years and older, investigators reported at the annual meeting of the American Association of Clinical Endocrinologists.

Nonfatal MI, nonfatal stroke, and the composite of doubling of serum creatine, end-stage renal disease, or renal death were lower in study participants aged 65 and older on canagliflozin. Lower risks of cardiovascular death and all-cause mortality were seen in participants under age 65 years who were taking canagliflozin. However, “these results should be interpreted with caution given the large number of subgroup analyses performed,” wrote Fernando Ovalle, MD, director of the multidisciplinary comprehensive diabetes clinic at the University of Alabama at Birmingham, and his colleagues.

Canagliflozin was found to reduce risk of the composite endpoint of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke versus placebo in previously published results of the CANVAS study, which included individuals with type 2 diabetes mellitus who either had or were at high risk for having cardiovascular disease.

The two multicenter, randomized, controlled trials, CANVAS and CANVAS-R, included more than 10,000 patients. The subgroup analysis presented here at the AACE meeting included 5,578 patients aged less than 65 years (55%) and 4,564 patients aged 65 years or older (45%).

The subgroup analysis found that placebo-subtracted differences in HbA1c were greater in patients under 65 years than those in patients 65 or older (–0.7% and –0.5%, respectively; P less than .0001). However, there were no significant differences by age group in body weight changes, systolic blood pressure, or diastolic blood pressure.

SOURCE: Ovalle F et al. AACE 2018, Abstract 233.

BOSTON – The effects of canagliflozin on hemoglobin A_1c levels were greater in participants under age 65 years in randomized clinical trials of the SGLT2 inhibitor, according to results of a prespecified subgroup analysis.

Some cardiovascular, renal, and mortality outcomes also varied by age group, according to the analysis of participants in the CANVAS (Canagliflozin Cardiovascular Assessment Study) program. Despite those differences, the effect of canagliflozin was generally consistent on other outcomes, such as body weight and blood pressure, in patient grouped into those aged less than 65 years and those aged 65 years and older, investigators reported at the annual meeting of the American Association of Clinical Endocrinologists.

Nonfatal MI, nonfatal stroke, and the composite of doubling of serum creatine, end-stage renal disease, or renal death were lower in study participants aged 65 and older on canagliflozin. Lower risks of cardiovascular death and all-cause mortality were seen in participants under age 65 years who were taking canagliflozin. However, “these results should be interpreted with caution given the large number of subgroup analyses performed,” wrote Fernando Ovalle, MD, director of the multidisciplinary comprehensive diabetes clinic at the University of Alabama at Birmingham, and his colleagues.

Canagliflozin was found to reduce risk of the composite endpoint of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke versus placebo in previously published results of the CANVAS study, which included individuals with type 2 diabetes mellitus who either had or were at high risk for having cardiovascular disease.

The two multicenter, randomized, controlled trials, CANVAS and CANVAS-R, included more than 10,000 patients. The subgroup analysis presented here at the AACE meeting included 5,578 patients aged less than 65 years (55%) and 4,564 patients aged 65 years or older (45%).

The subgroup analysis found that placebo-subtracted differences in HbA1c were greater in patients under 65 years than those in patients 65 or older (–0.7% and –0.5%, respectively; P less than .0001). However, there were no significant differences by age group in body weight changes, systolic blood pressure, or diastolic blood pressure.

SOURCE: Ovalle F et al. AACE 2018, Abstract 233.

SAN DIEGO – In patients on long-term triple therapy and up to one exacerbation in the previous year, the withdrawal of inhaled corticosteroids (ICS) led to a small decrease in lung function that was not clinically important, with no associated difference in the rates of chronic obstructive pulmonary disease (COPD) exacerbations, dyspnea or as-needed bronchodilator use.

Those are key findings from the SUNSET trial, a 26-week, randomized, double-blind, parallel-group multicenter study to assess the efficacy and safety of the switch from long-term triple therapy to indacaterol/glycopyrronium (IND/GLY, 110/50 mcg once daily) or continuation of triple therapy with tiotropium 18 mcg once daily and salmeterol/fluticasone propionate fixed-dose combination 50/500 mcg b.i.d.

SOURCE: Chapman K et al. ATS 2018 Abstract A1009.

SAN DIEGO – In patients on long-term triple therapy and up to one exacerbation in the previous year, the withdrawal of inhaled corticosteroids (ICS) led to a small decrease in lung function that was not clinically important, with no associated difference in the rates of chronic obstructive pulmonary disease (COPD) exacerbations, dyspnea or as-needed bronchodilator use.

Those are key findings from the SUNSET trial, a 26-week, randomized, double-blind, parallel-group multicenter study to assess the efficacy and safety of the switch from long-term triple therapy to indacaterol/glycopyrronium (IND/GLY, 110/50 mcg once daily) or continuation of triple therapy with tiotropium 18 mcg once daily and salmeterol/fluticasone propionate fixed-dose combination 50/500 mcg b.i.d.

SOURCE: Chapman K et al. ATS 2018 Abstract A1009.

SAN DIEGO – In patients on long-term triple therapy and up to one exacerbation in the previous year, the withdrawal of inhaled corticosteroids (ICS) led to a small decrease in lung function that was not clinically important, with no associated difference in the rates of chronic obstructive pulmonary disease (COPD) exacerbations, dyspnea or as-needed bronchodilator use.

Those are key findings from the SUNSET trial, a 26-week, randomized, double-blind, parallel-group multicenter study to assess the efficacy and safety of the switch from long-term triple therapy to indacaterol/glycopyrronium (IND/GLY, 110/50 mcg once daily) or continuation of triple therapy with tiotropium 18 mcg once daily and salmeterol/fluticasone propionate fixed-dose combination 50/500 mcg b.i.d.

SOURCE: Chapman K et al. ATS 2018 Abstract A1009.